France

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Health systems in transition
France
as shown by the fact that the national ceiling for SHI expenditure has been
underspent since that time, while the percentage of OOP expenditure has
remained stable over the same period.
7.1 Stated objectives of the health system
Under the 1946 Constitution, the French State guarantees health protection to
all, a right that dates back to the 1789 Declaration of the Rights of Man and of
the Citizen. The 2004 Health Insurance Act sets out the stated objectives of the
French health system:
• universal coverage, independent of age or health status;
• equitable access to health care;
• equitable contribution to the costs of the health care system; every
person is expected to contribute, to the extent of his/her capacity, to the
appropriate use of the resources endowed by the nation to SHI; and
• continuity, coordination, and effectiveness of care.
France’s average life expectancy of over 80 years is in part a testament
to the combination of broad access to health care and strong public health
policies. Despite these positives, weaknesses remain. Major problems include
lack of coordination between hospital and ambulatory services, geographic
disparities in health care resources and financial barriers to some specialists
because of extra-billing and certain services and devices having poor SHI
coverage. In the broader economic context, high levels of health expenditure
and chronic deficits have raised questions about the financial sustainability of
the system, particularly in light of the growing demand for health services by
an ageing population.
In terms of governance, increased responsibility for coordination and
planning of the French health care system has devolved to the regional level
over the last decades and in particular from 2010. However, the National
Health Conference, an advisory body to the Ministry in charge of Health, has
criticized the governance at the national level as fractured and bureaucratic,
thereby impeding progress in organization and coordination at the regional
level (National Health Conference, 2013). Such structural impediments may
also hinder development of Health in All policies at the national level (Leppo
et al., 2013). Political commitment to intersectoral approaches, while strong in
certain areas such as emergency response, nutrition and the fight against illegal